De novo and apparent de novo hepatitis B virus infection after liver transplantation

• Published in: Journal of hepatology 1997-03, Vol.26 (3), p.517-526
• Main Authors: Roche, Bruno, Samuel, Didier, Gigou, Michele, Feray, Cyrille, Virot, Veronique, Schmets, Laurent, David, Marie Françoise, Arulnaden, Jean Louis, Bismuth, Alain, Reynes, Michel, Bismuth, Henri
• Format: Article
• Language: English
• Subjects: Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Biomarkers; DNA, Viral - analysis; Female; Follow-Up Studies; Graft Rejection - immunology; Graft Rejection - pathology; Graft Rejection - therapy; Hepatitis B; Hepatitis B - epidemiology; Hepatitis B - etiology; Hepatitis B - transmission; Hepatitis B Antibodies - analysis; Hepatitis B Surface Antigens - immunology; Hepatitis B virus - genetics; Hepatitis B virus - immunology; Human viral diseases; Humans; Immunohistochemistry; Infectious diseases; Liver transplantation; Liver Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Polymerase Chain Reaction; Prevalence; Recurrence; Reoperation; Retrospective Studies; Survival Rate; Transplantation, Homologous - pathology; Treatment Outcome; Viral diseases; Viral hepatitis
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/S0168-8278(97)80416-3

Background/Aims: The aim of this study was to clarify the aetiology of apparent de novo HBV infection after liver transplantation. Methods: Twenty out of 570 HBsAg negative patients (3.5%) became HBsAg positive after transplantation and were studied. Donor and recipient sera were retrospectively tested for HBsAg, anti-HBs, anti-HBc, and HBV DNA by PCR. Donor and recipient livers were tested for HBV DNA by PCR on paraffin-embedded tissue. Results: Group 1: HBV infection of donor origin (eight patients): one donor serum was HBsAg positive, three were serum HBV DNA positive, four were liver HBV DNA positive. Group 2: reactivation of latent HBV infection (eight patients) with detection of HBV DNA in pretransplant serum (seven patients) or in native liver (one patient): three were anti-HBs positive, two anti-HBc positive, and three with fulminant hepatitis had no serological HBV markers. Group 3: undetermined origin (four patients) defined by absence of HBV DNA in pretransplant donor and/or recipient sera and liver; however, acquired infection was suspected from two anti-HBs and anti-HBc positive donors. Two patients became HBsAg negative, and five HBV DNA negative. One died from HBV-cirrhosis and two were retransplanted. In the others, the last histology showed cirrhosis (three), chronic hepatitis (nine), acute hepatitis (one), and non-specific change (four patients). Conclusions: The prevalence of de novo HBV infection in liver transplant patients was 3.5%; the aetiology was determined in 16 20 patients: from the donor in eight, and from the recipient in eight. One should be cautions when donors or recipients are anti-HBc or both anti-HBs and anti-HBc positive.